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Background: Bypass grafting for chronic total occlusions remains surgically challenging and controversial. Therefore, we evaluated the incidence and clinical outcomes of revascularization on chronic total occlusions undergoing coronary artery bypass surgery.Methods: Among 828 patients who underwent isolated coronary artery bypass surgery from January 2010 to December 2018, 245 patients (29.5%) diagnosed with at least one chronic total occlusion were included and retrospectively reviewed. Primary endpoints were 30-day and overall mortality. Secondary endpoint was the composite outcome of major adverse cardiac and cerebrovascular events. Results: With a mean follow-up of 56.6 ± 6.5 months in 245 patients with chronic total occlusions, 51 patients (20.9%) received incomplete revascularization for chronic total occlusions. Risk factor analysis showed that incomplete revascularization was associated with increased 30-day (odds ratio 8.62; 95% confidence interval (CI) 1.64 – 50; p = 0.011) and overall mortality (hazard ratio (HR) 2.13; 95% CI 1.07 – 4.21; p = 0.03). ICR also increased the risk of major adverse cardiac and cerebrovascular events (HR 1.98; 95% CI 1.12 – 3.54; p = 0.01). Freedom from overall mortality was 92.8%, 90.4%, and 86.8% in the complete revascularization group, and 86.3%, 80.0%, and 72.7% in the incomplete revascularization group, at 1, 3, and 5 years, respectively (p = 0.004).Conclusions: In patients with chronic total occlusions undergoing coronary artery bypass surgery, the rate of incomplete revascularization was 20.9%, and it significantly increased the risk of mortality and major adverse cardiac and cerebrovascular events. Further studies in a large cohort are needed.

Cardiac myxoma is rare in children and often associated with cerebrovascular events. Reported herein is the case of a 9-year-old boy who presented with acute obstruction of the aortic bifurcation associated with a huge left atrial (LA) myxoma, thereby leading to acute ischemia of the lower extremities. Immediate surgical removal of the LA myxoma with concomitant percutaneous embolectomy using a Forgathy catheter was done, with relief of ischemic symptoms. Cardiac myxoma should always be considered in the case of acute embolic events in children, given that it needs immediate intervention to prevent further complications.

Many predictive models have been proposed for better stratification of diffuse large B-cell lymphoma (DLBCL). Hans' algorithm has been widely used as standard to sub-classify DLBCL into germinal center B-cell (GCB) and non-GCB origins. However, there have been disagreements in the literature regarding its prognostic significance. Here, we retrospectively analyzed Hans' algorithm and the individual immunohistochemical biomarkers at different cut-off values (5%, 30%, 50% or 75%) in 94 Korean patients with DLBCL treated with combination chemotherapy with cyclophosphamide, daunorubicin, vincristine, and prednisone. No significant differences were observed between the GCB (18 patients, 19.1%) and non-GCB (76, 80.9%) groups. Among individual biomarkers, CD10 negativity (cut point: 30%) and bcl-6 positivity (cut point: 5%) were independent good prognostic markers in progression-free survival (PFS), whereas bcl-6 (cut point: 5%) positivity was an independent good prognostic marker in overall survival irrelevant of international prognostic index. The present study showed the lack of predictability of Hans' algorithm in DLBCL patients, and that CD10, Bcl-6 may have diverse prognostic significance at different cut-off values. Our results suggest that the proposed cut-off value may not be applied universally, and that the optimal cut-off value may need to be optimized for individual laboratory.

A right coronary artery to left ventricular fistula with a giant right coronary artery aneurysm is a very rare condition. This requires surgical treatment because of the possibility of rupture of aneurysm, heart failure and infective endocarditis. A 47 years old male patient with dyspnea on exertion for 3 months was diagnosed as having a right coronary artery to left ventricular fistula with a giant right coronary artery aneurysm according to the CT and coronary artery angiography. We resected the aneurysm and performed a coronary artery bypass graft. (Korean J Thorac Cardiovasc Surg 2010;43:296-299)

A 62-year-old woman with Takayasu arteritis and 2 prior aortic valve replacements, was admitted with unstable angina. Computed tomographic angiography showed a newly developed right coronary artery-to-right bronchial artery fistula. Because of dense aortic calcification, catheter embolization was undertaken, which was successful. We believe the acquired coronary artery fistula developed after her uneventful second aortic valve surgery, due to inevitable trauma to the mediastinum and ascending aorta, and partly due to her underlying Takayasu arteritis.

Cardiac myxoma is rare in children and often associated with cerebrovascular events. Reported herein is the case of a 9-year-old boy who presented with acute obstruction of the aortic bifurcation associated with a huge left atrial (LA) myxoma, thereby leading to acute ischemia of the lower extremities. Immediate surgical removal of the LA myxoma with concomitant percutaneous embolectomy using a Forgathy catheter was done, with relief of ischemic symptoms. Cardiac myxoma should always be considered in the case of acute embolic events in children, given that it needs immediate intervention to prevent further complications.

Background Postoperative acute pain can cause anxiety and decrease the quality of life in patients. Acute sternal bone pain after cardiac surgery can persist for long time. Objective The aim of this study is to explore the relationships between the degree of sternal misalignment and the degree of acute sternal pain after coronary artery bypass grafting surgery (CABG). Methods We retrospectively reviewed postoperative coronary computed tomographic (CT) angiography and medical records in 104 patients who received CABG between May 1, 2009 and January 31, 2011. CT scan was classified into five categories, and we compared the degree of misalignment and subjective pain via numerical rating scale (NRS) system. Results Positive correlation was noted between NRS and the degree of sternal misalignment (Pearson correlation coefficient 0.660, p = 0.000). Conclusion Postoperative sternal pain is related to the degree of misalignment of the sternal halves. It would be appropriate for surgeons to approximate the sternal halves accurately to decrease the postoperative sternal wound pain in the first place.

The aortic connector system may reduce stroke during proximal venous anastomosis. However, the overall anastomotic patency rate has been generally reported to be low. From October 2002 to March 2004, 68 patients who received proximal anastomosis using the St. Jude Aortic Connector System were included in the study. There were 47 men and 21 women and their mean age was 65.68+/-6.68 yr old (52 to 85 yr). Grafts were evaluated by coronary angiography or multi-slice 16 channel 3-D CT at 6 days and at 6 months postoperatively. In the immediate postoperative period, no stenosis was observed by either angiography (n=22) or 3D CT (n=46). At 6-month postoperatively, we performed either angiography (n=7) or 3-D CT (n=52). Of these patients, 5 patients showed graft stenosis in the midportion, and 3 in the ostium. There were no stroke. Simple, and effective proximal anastomosis with good protection from cerebrovascular accident was achieved especially when calcification or atheromatous plaque was observed at the ascending aorta in the operation room. However, our mid term patency results raise concerns related to venous graft stenosis in the midportion. Therefore, longer follow up is recommended.

Objective: To determine the significance of β1 integrin expression as a prediction marker for the response to radiotherapy in patients with early glottic carcinoma. Study Design: Retrospective study in a tertiary referral center. Methods: Among the T1/T2 glottic carcinoma patients treated with radiotherapy from 1992 to 2002, 52 had more than 2 years of follow-up and available pretreatment biopsy specimens. The immunohistochemical staining was performed for the assay of β1 integrin expression, and the staining pattern of each was classified as diffuse, localized, or negative. The associations between the patterns of β1 integrin expression and clinicopathologic parameters, including response to radiotherapy, involvement of the anterior commissure, and grade of histologic differentiation, were evaluated. Results: After radiotherapy, 42 patients remained tumor free, and 10 patients had recurrent or persistent disease. Six (12%) specimens were negative for β1 integrin expression, 39 (75%) had a localized staining pattern, and 7 (13%) had a diffuse staining pattern. Recurrence rate was significantly higher in the diffuse group (53%) than in the localized (13%) or negative (17%) groups (P = .023). The pattern of β1 integrin expression was also closely related to histologic differentiation (P = .008), although the association between response to radiotherapy and histologic differentiation was not significant Conclusion: The pattern of expression of β1 integrin, which has been known as a stem cell marker of the epidermis, may be helpful in predicting the response to radiation in patients with early glottic carcinoma.

Although unilateral antegrade selective cerebral perfusion (UASCP) is considered a safe cerebral protection strategy during aortic surgery, an optimum temperature remains to be defined. This study compared outcomes in patients undergoing UASCP at either